Page 1251 - Clinical Immunology_ Principles and Practice ( PDFDrive )

1212 Part ten Prevention and Therapy of Immunological Diseases

persons (Fig. 90.1). Other opponents of vaccination were those
with financial interests in lucrative variolation practices. When
vaccination in England was made compulsory by the Vaccination
Act of 1853, an organized antivaccination movement arose almost
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immediately. Incredibly, even in the present day, despite all the
evidence supporting the safety and effectiveness of licensed vaccines,
organized antivaccination movements continue to challenge
contemporary clinicians and public health officials. The explosive
growth of the Internet in the last 2 decades has made it relatively
easy to self-publish anything and everything, and this has resulted
in rapid and wide dissemination of misinformation about vaccines,
antivaccination propaganda, and pseudoscience that obstructs
traditional scientific evaluation and further feeds the general
public’s fears and misunderstandings.
It is worth noting that Jenner’s work of 220 years ago encapsulates
many of the elements of today’s translational vaccinology.
FIG 90.1 Antivaccination Caricature by James Gillray From
1802 Entitled “The Cow-Pock—or—The Wonderful Effects KeY COnCePtS
of the New Inoculation!” Directed Against Jenner and His Edward Jenner’s Work Relevant to Translational
Work to Promote Smallpox Vaccination. (Originally by James Vaccinology Today
Gillray, The Cow-Pock—or—the Wonderful Effects of the New
Inoculation! (1802). vide. the Publications of the Anti-Vaccine • Disease burden, surveillance, epidemiology: A significant and
Society. Print (color engraving) published June 12, 1802 by H. unacceptable burden of smallpox disease drove development of a
safer intervention to improve health.
Humphrey, St. James’s Street. Library of Congress, Prints & • Innovation: Jenner’s innovation resulted from the need for an improved
Photographs Division.) biomedical intervention given the significant risk of harm associated
with the centuries old variolation practice.
• Clinical insight: An observation that dairymaids who had recovered
from an occupational illness (cowpox) were seldom affected by smallpox
stock. Young Phipps survived both the vaccination and the led to Jenner’s promotion of smallpox vaccination. The observation
challenge, and Jenner first reported his experiment in 1797 in a of the protected state (immunity) in dairymaids led to a concept that
short communication to the Royal Society. After Jenner’s initial was tested and promoted by Jenner.
report submitted for publication was rejected, he added a few • Postvaccination challenge: After the vaccination procedure, Jenner’s
more cases of his vaccine experiment (including one on his own subjects were subsequently intentionally exposed to (challenged with)
wild-type smallpox and observed for safety and disease outcomes.
son), and in 1798, he reported his findings in a self-published This would not be permissible today in smallpox research, although
booklet entitled “An inquiry into the causes and effects of the human challenge experiments are performed for certain self-limiting
variolae vaccinae, a disease discovered in some of the western or treatable infectious diseases.
counties of England, particularly Gloucestershire, and known • Presentation of experimental results: To disseminate the scientific
by the name of the cow pox.” 18 information and advocate for wider vaccination deployment, Jenner
presented his work to the Royal Society. He self-published his manu-
script after it was rejected by the Society.
CLInICaL reLeVanCe • Branding: The name “vaccination” was applied to the intervention.
Vacca is the Latin word for “cow.”
Why vaccines are critical interventions for every • antivaccination movement and conflicts of interest: Jenner
medical practice experienced significant opposition to his vaccine from groups opposed
to the new technique and from individuals who had vested interests
• Vaccines are highly effective interventions for preventing infectious in variolation practices and stood to lose their business if the concept
diseases and have public health importance. of vaccination caught on.
• Both individual protection and community (herd) immunity result from
vaccination programs.
• The reductions in disease burden (morbidity and mortality) achieved Although Jenner’s smallpox challenge experiment would not
through implementation of childhood vaccination programs are be approved by today’s institutional research boards (IRBs, or
extraordinary.
• In the last several years, new adolescent and adult vaccines have ethics committees), certain human challenge studies remain both
become available and are now recommended. Vaccination is not just acceptable and valuable today. The postvaccination challenge
for children anymore. experiment can be an important process to efficiently obtain
• Clinicians of all specialties should take vaccine histories and provide preliminary protective efficacy information for a vaccine and
access to vaccines relevant to their patients’ ages and medical condi- has been shown in early-phase clinical trials to be safe, well
tions. Access can be provided through referral or by stocking and tolerated, and immunogenic. Human challenge studies are
administering the indicated vaccines.
performed for self-limiting and/or treatable infections to study
vaccine protection or to characterize host response to infection
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This self-published report and Jenner’s subsequent use of in detail (e.g., influenza, primary dengue, norovirus, and
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cowpox vaccination were greeted with mixed reaction. Jenner’s malaria ). A human challenge experiment can rapidly provide
work was considered controversial by some because of the feedback to vaccine developers and public health officials to help
introduction of a cow virus into humans. A famous satirical cartoon prioritize resource-intensive field trial evaluations of promising
by James Gillray depicts cow parts emerging from vaccinated candidate vaccines. If an encouraging preliminary efficacy signal